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Maximize Your Oral Cancer Screening Reimbursement

Mar 1, 2021

Many practices can find themselves in a grey area when it comes to charging issues for oral cancer exams. Your dental practice may be unsure of what fee to charge, what ADA code to bill or whether insurance companies will reimburse this fee. Below is an easy-to-read guide on what ADA codes to use for an oral cancer screening exam and other biopsy procedures.

D0431 – This is an adjunctive pre-diagnostic test that assists with the detection of mucosal abnormalities, including premalignant and malignant lesions. It does not include cytology or biopsy procedures.

Keep in mind that D0431 is a pre-diagnostic test and not the actual biopsy procedure. Additionally, this code should only be billed when the dentist has completed both a physical and visual exam on the patient.

Code D0431 applies to these commonly used systems: OralID, ViziLite, MicroLux, VELScope and Identafi.

The codes below are typically reimbursed when accompanied by a doctor’s narrative and pathology report.

D7285 – Incisional Biopsy of Oral Tissue – HARD
D7286 – Incisional Biopsy of Oral Tissue – SOFT
D7287 – Exfoliative Cytological Sample Collection
D7288 – Brush Biopsy – Transepithelial Sample Collection

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